何燕行 杜爱丽

【摘要】 目的 探討腹腔镜下子宫肌瘤剔除术治疗多发性子宫肌瘤的临床效果。方法 70例多发性子宫肌瘤患者， 根据患者手术方式的不同分为对照组以及研究组， 每组35例。对照组接受开腹手术治疗， 研究组接受腹腔镜下子宫肌瘤剔除术治疗。比较两组患者手术指标（手术时长、术中出血量、首次下床时间、住院时长）;术后24 h血白细胞（WBC）计数升高值与术后发热率;治疗3个月后卵泡刺激素（FSH）、促黄体生成素（LH）、雌二醇（E2）水平;术后肌瘤残留、1年肌瘤复发情况及术后妊娠情况。结果 两组患者的手术时长比较差异无统计学意义（P>0.05）;研究组患者的术中出血量（79.58±4.11）ml少于对照组的（87.58±5.41）ml， 首次下床时间（1.15±0.36）d、住院时长（5.68±0.44）d均短于对照组的（2.32±0.44）、（7.35±0.55）d， 差异具有统计学意义（P<0.05）。研究组患者术后24 h血WBC计数升高值（4.05±0.93）×109/L低于对照组的（8.35±1.23）×109/L， 术后发热率5.71%低于对照组的22.86%， 差异具有统计学意义（P<0.05）。治疗3个月后， 两组患者的FSH、LH、E2水平比较差异无统计学意义（P>0.05）。两组患者术后肌瘤残留率、1年肌瘤复发率比较差异无统计学意义（P>0.05）。随访1年， 研究组妊娠8例（22.86%）， 对照组妊娠9例（25.71%）， 两组妊娠率比较差异无统计学意义（P>0.05）;两组妊娠结局均无子宫破裂发生。结论 多发性子宫肌瘤患者接受腹腔镜下子宫肌瘤剔除术治疗， 术后恢复快， 并发症少， 内环境干预少， 手术效果跟开腹手术无明显差异。

【关键词】 腹腔镜;多发性子宫肌瘤;子宫肌瘤剔除术;临床效果

DOI：10.14163/j.cnki.11-5547/r.2020.20.007

【Abstract】 Objective   To discuss the clinical effect of laparoscopic myomectomy on the treatment of multiple hysteromyoma. Methods   A total of 70 patients with multiple hysteromyoma were divided into control group and research group by different surgical methods， with 35 cases in each group. The control group was treated by open surgery， and the research group was treated by laparoscopic myomectomy. The surgical indicators （operation time， amount of intraoperative hemorrhage， fist-time off-bed activity time and hospitalization time）， increase of 24 h postoperative white blood cell （WBC） count and postoperative fever rate， follicle-stimulating hormone （FSH）， luteinizing hormone （LH）， and estradiol （E2） levels after 3 months of treatment， postoperative myoma residual， 1-year recurrence and pregnancy status were compared between the two groups. Results   There was no statistically significant difference in operation time between the two groups （P>0.05）. The amount of intraoperative hemorrhage （79.58±4.11） ml of the research group was less than that of the control group （87.58±5.41） ml， and fist-time off-bed activity time （1.15±0.36） d and hospitalization time （5.68±0.44） d were shorter than those of the control group （2.32±0.44） and （7.35±0.55） d， and the difference was statistically significant （P<0.05）. The increase of 24 h postoperative count （4.05±0.93）×109/L of the research group was lower than that of the control group （8.35±1.23）×109/L， and postoperative fever rate 5.71% was lower than that of the control group 22.86%， and the difference was statistically significant （P<0.05）. 3 months after treatment， there was no statistically significant difference in levels of FSH， LH and E2 between the two groups （P>0.05）. There was no statistically significant difference in postoperative myoma residual rate and 1-year recurrence rate between the two groups （P>0.05）. 1 year after follow-up， there were 8 pregnancy cases （22.86%） in the the research group and 9 pregnancy cases （25.71%） in the control group. There was no statistically significant difference in the pregnancy rate between the two groups （P>0.05）. No uterine rupture occurred in both groups. Conclusion   For patients with multiple hysteromyoma， laparoscopic myomectomy shows quicker recovery， fewer complications， less internal environmental intervention， and the surgical effect is not significantly different from open surgery.

【Key words】 Laparoscopic ; Multiple hysteromyoma; Myomectomy; Clinical effect

子宫肌瘤属于妇科常见疾病， 大多数子宫肌瘤均属于良性肿瘤， 常见于患者的子宫平滑肌的结缔以及纤维组织中， 患者会伴随子宫出血、月经量异常增多等症状， 对患者的生育功能影响较大[1， 2]。子宫肌瘤呈现多发性， 且好发于育龄期女性， 约有20%以上……